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Policies of Children’s Hospitals on Donation After Cardiac Death—Reply
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In Reply: Drs de Groot and Kompanje identify important ongoing issues regarding the declaration of death and DCD. However, they fail to acknowledge ongoing criticism of current neurological criteria of death, insufficiently characterize the duration of ischemia needed for irreversible cessation of all functions of the entire brain, and hold DCD to a higher standard of irreversibility than is used in other clinical contexts.
In their letter, de Groot and Kompanje focus on loss of brain function as the fundamental criterion of death. There has been, however, substantial criticism of this approach. Critics argue that individuals fulfilling neurological criteria may retain integrative function of the posterior pituitary and do not inevitably progress to cardiac arrest quickly.1 Thus, the premise stated by de Groot and Kompanje may be equally problematic as what they criticize.
They note that anoxia begins to kill brain cells after 4 minutes and that 7 institutions require . . . [Full Text of this Article]
Armand H. Matheny Antommaria, MD, PhD
armand.antommaria@hsc.utah.edu
Department of Pediatrics
University of Utah School of Medicine
Salt Lake City
Joel Frader, MD, MA
Department of Pediatrics
Northwestern University Feinberg School of Medicine
Chicago, Illinois
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RELATED LETTER
Policies of Children’s Hospitals on Donation After Cardiac Death
Yorick J. de Groot and Erwin J. O. Kompanje
JAMA. 2009;302(8):844.
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